腰丛-坐骨神经阻滞对高龄全髋关节置换术术后转归的影响  

Effects of lumbar:plexus -sciatic nerve block on postoperative outcome in elderly patients after total hip arthroplasty

作　　者：秦爱敏[1] 马春宇 张增梅[1] 赵海运[1] 李丽伟[3] Qin Aimin;Ma Chunyu;Zhang Zengmei;Zhao Haiyun;Li Liwei(Department of Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Institute of Clinical Medical Research of Universities of Henan Province,Zhengzhou 450052,China;Department of Anesthesiology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052, China)

机构地区：[1]郑州大学第一附属医院外科医学部,450052 [2]河南省高等学校临床医学重点学科开放实验室,郑州450052 [3]郑州大学第一附属医院麻醉科,450052

出　　处：《中华实验外科杂志》2019年第1期157-159,共3页Chinese Journal of Experimental Surgery

摘　　要：目的观察腰丛-坐骨神经阻滞复合全麻(LPSN)对高龄患者行全髋关节置换术术后转归的影响。方法70例择期行全髋关节置换术患者随机分为LPSN组和单纯全麻(GA)组,每组35例,LPSN组术中以腰丛-坐骨神经阻滞后行全身麻醉;GA组以常规全身麻醉。在入室5 min(T0)、术后3 h(T1)、术后24 h(T2)及术后48 h(T3)记录脉搏血氧饱和度(SpO2)、心率(HR)、平均动脉压(MAP)和疼痛视觉模拟评分(VAS),记录手术时间,术中瑞芬太尼用量,术后拔管时间,术后1周呼吸系统并发症发生,住院时间。结果与GA组比较,LPSN组VAS评分在T1、T2均降低[(2.5±1.4)分比(3.2±1.4)分,(1.9±1.2)分比(2.7±1.2)分,P<0.05];瑞芬太尼用量明显减少[(0.6±0.1) mg/h比(0.8±0.1) mg/h,t=-8.823,P<0.01];术后拔管时间缩短[(18.2±2.9) min比(24.9±3.5) min,t=-8.821,P<0.01];术后1周呼吸系统并发症发生率降低(8.57%比28.57%,χ^2=4.838,P<0.05),差异有统计学意义;在平均住院天数(15.1±1.8)d比(15.9±1.9) d,差异无统计学意义(t=-1.676,P>0.05)。 结论LPSN对高龄患者行全髋关节置换术可减少瑞芬太尼用量,降低围术期呼吸系统并发症发生率,有利于术后转归。Objective To investigate the effects of lumbar plexus-sciatic nerve block combined with general anesthesia on postoperative outcome in elderly patients after total hip arthroplasty.Methods Seventy elderly patients who were scheduled for total hip arthroplasty were randomly divided into two groups: group LPSN (n=35) and group GA (n=35), lumbar plexus-sciatic nerve block combined with general anesthesia were performed in patients of group LPSN, patients in group GA were performed with general anesthesia. saturation of pulse oximetry (SpO2), Visual analogue scale (VAS) before anesthesia (T0), at 3 h (T1), 24 h (T2), 48 h (T3) after anesthesia, operation time, the remifentanil consumption, time to remove the tracheal tube, the incidence of respiratory events and the length of stay were recorded.Results As compared with group GA, the VAS of group LPSN was reduced at T1, T2[(2.5±1.4) vs. (3.2±1.4), (1.9±1.2) vs. (2.7±1.2), P<0.05], The dosages of remifentanil were significantly decreased [(0.6±0.1) mg/h vs. (0.8±0.1) mg/h, t=-8.823, P<0.01], the time to remove the tracheal tube was shorter too[(18.2±2.9) min vs. (24.9±3.9) min, t=-8.821, P<0.01], the incidence rate of respiratory events was less than that in group GA (8.57% vs. 28.57%, χ^2=4.838, P<0.05);and the average length of stay in two groups were no significant difference[(15.1±1.8) d vs. (15.9±1.9) d, t=-1.676, P>0.05]. Conclusion lumbar plexus-sciatic nerve block combined with general anesthesia could decrease the use of remifentanil in elderly patients after total hip arthroplasty, have a fewer incidence of respiratory events, and it is beneficial to the early postoperative rehabilitation.

关 键 词：神经阻滞 高龄 关节成形术 术后转归 

分 类 号：R614[医药卫生—麻醉学]